When Dental Drama Threatens Your Au Pair’s Extension

by cv harquail on June 4, 2015

Dental insurance in the USA is pretty crummy.  Or at least the insurance we have is — I swear that there’s never a procedure that’s completely covered or enough coverage to make it through the year.  I supposed I should take this up with the HR department? But I guess I should be happy that we have dental insurance that covers something.

8309413cce37e09ac504392d36a9727eI feel for au pairs who have dental issues when they’re here in the USA.

[See “Medical Care for your Au Pair: Your responsibility?” for the story of my Au Pair’s dental emergency…]

I don’t know the details of each Au Pair Agency’s Dental Coverage (and LCCs, if you’d add links in the comments that would be great!). But none of the policies are as cost effective as the ones in many Au Pairs’ home countries, where their national plans make decent care affordable or even free.

BostonAreaHostMom emailed us for some emergency dental-related advice for her au pair. Her au pair needs significant work done, right away.

The Au Pair could go back home for the work, but might run up against the expiration date of her visa and be unable to come back to the USA to finish out her 6 month extension.  And, of course BAHM doesn’t have the resources to pay for the Au Pair’s dental care from the family budget.

Any good ideas for her? Here are the deets:   

I have hosted au pairs for 8 years and have never come across this issue.

My current au pair is 25 and she has all of her wisdom teeth intact. She recently developed an infection in the gums around one of her wisdom teeth. She went to Tufts Dental School in Boston, MA (we live in the South Shore) because they offer lower cost dental care. The dentist tried to clean out the infection, told her to rinse with saltwater and said that if that doesn’t work she will have to have her wisdom teeth removed. Apparently the infection has spread to the bone around her tooth.

It costs $4,000 to have all her wisdom teeth removed at the dental school, $1,000 for one tooth. Our au pair may have to go back to the EU if she has to have her wisdom teeth removed (because it will be covered by insurance in her home country) and her Visa expires in July (although she extended until January) so she would not be able to return to finish out her time in the US. I have two questions.

1. Are there any patient assistance, charity programs for patients that don’t have money to pay for dental procedures like this? What should she do?

2. The dentist didn’t give her a prescription for antibiotics, for any dentist host parents out there, shouldn’t she have been given an antibiotic to help clear up the infection?

Our au pair just joined our family a month ago through rematch and will only be with us until January but she is an awesome au pair, a great person, and we all really like her and don’t want her to have to go back home. Other than paying for her wisdom tooth extraction (finances are tight) is there anything else we can do?

I appreciate any advice you can give me!

Warm Regards,

?Boston Area Host Mom


WarmStateMomma June 4, 2015 at 4:01 pm

Aren’t the 4 wisdom teeth in different locations such that the infection wouldn’t just spread to the others? If only one is infected, can she have just that one removed now? If you can remove one for $1,000, that’s probably closer to the cost of her airfare home early for the procedure.

If she has to return early for dental work, you may have some childcare coverage gaps and extra expenses. I’d consider contributing something toward her dental costs to avoid those other expenses.

DC Metro Au Pair June 4, 2015 at 5:49 pm


I’ve been an Au pair with APIA in DC for the past 9 months and I had the same problem in March.
Two of my wisdom teeth got infected and I had to have all four removed here. However the price was 2 500 dollars for all four teeth ( still a lot from a European prospective :/). My insurance is CISI and it covered 1185 dollars. I had to pay the rest. My advice is to try a different dentist office and try and get a more reasonable price. I can’t imagine having to pay 4 000 dollars!

Host Mom X June 4, 2015 at 5:53 pm

I have no advice except for I’m so sorry about this and good luck, to both you and the AP! Having spent many years without dental insurance going to my city’s stuDENTS, I feel for your AP even should she be able to finance that procedure…..

Kate June 4, 2015 at 6:27 pm

In New York Dental Schools offer significantly reduced rates.

NJmama June 4, 2015 at 6:29 pm

What an awful awful situation. I wish I had advice but I wouldn’t know where to start either!

HRHM June 4, 2015 at 9:44 pm

First, get a second opinion about what absolutely MUST be done now. PP had a great point about the 4 teeth being in entirely different locations and the infection of one having NOTHING to do with the other 3.

Secondly, as far as I can tell, none of my APs have had ANY dental coverage in their CC, APIA or APC travel insurance, BUT, they do have hospital and emergency care. So, if she has an abscess and can get an oral surgeon to admit her via the ER to a hospital and take her to the OR to drain her abscess and pull the tooth, then it’s an emergency medical procedure and would be covered just like if she had to go in for an emergency appendectomy. It will cost the insurance company probably 4 times what getting it done in the dentist office does, but only cost her the copay/deductible.

NoVA Twin Mom June 5, 2015 at 9:11 am

That was my thought too – way off topic, but my brother is severely mentally impaired and on medicaid, *some* of his “dental” care (but you can’t call it that) can be paid through his health insurance IF it is done at a hospital under general anestheasia (needless to say, his teeth have gotten really bad over the years – you don’t move to this level of treatment as a first choice just as a way to get insurance to pay for things it otherwise wouldn’t). I don’t know the details, but do know enough to look into this.

Dorsi June 5, 2015 at 4:14 pm

ERs won’t admit patients for dental procedures. Doesn’t happen. She will be given antibiotics (probably), pain meds (maybe) and a list of low cost dental providers, and a $250 bill for her co-pay.

NoVA Twin Mom June 6, 2015 at 7:27 am

Both of us are saying you can’t start with the ER, you have to start with another doctor that you already have, then they work through an existing relationship they have with the hospital. I’m not familiar with admitting through the ER either as I’m more familiar with this being done as a “same day stay” outpatient procedure, but if a doctor that doesn’t work in the ER has admitting privileges at a hospital and meets their existing patient at an ER, then HRHM’s plan would work.

But that’s not someone just walking in “cold” to the ER with a dental issue. If they did that, I agree they’d be lucky to get what you listed (particularly the pain meds).

Anon for this. June 7, 2015 at 1:26 am

In 10 years of work in the ER, I have never seen a doctor meet their patient in the ER to admit them, especially for a procedure which won’t pass utilization review. I haven’t in 5 year seen a primary care doctor admit their own patient under any circumstances – nearly all admissions are covered by by a hospitalist or a specialist. The vast majority of hospitals do not have an OMFS or dentist with OR privileges – so even if a primary care doctor admitted the patient, there would be no one to perform the procedure.

I don’t want to be harsh, but I want to suck all hope of using a hospital admission for routine dental care out of anyone reading this thread. (Or an ER for any kind of dental care). Unfortunately for the AP, wisdom teeth impaction is a routine and anticipated consequence of not having them removed. Of course, if one is having a life threatening medical emergency, they should march themselves right down to the ER – where they will get all the care until they can be seen by an appropriately qualified doctor – but the ER won’t set up or guarantee follow up care.

A fair analogy would be a breast lump – a problem that has the potential to be life-threatening and certainly warrants further testing. If you don’t have access to primary care to have your lump evaluated, you cannot be admitted to the hospital for a mammogram. Checking into the ER won’t get you a mammogram. Visiting an ER will probably get you a list of free/sliding-scale clinics who can evaluate your problem. It is an unfortunate system.

Dorsi June 5, 2015 at 4:15 pm

A local ER will have a comprehensive list of low-cost dental resources.

WestMom June 5, 2015 at 6:20 am

I am so sorry about your situation. Does your family have a dentist? Would s/he consider doing the work at discount? We had an AP years ago who needed her tooth filled, and a root canal, and both the dentist and oral surgeon did the work for free. Doesn’t hurt to ask… Maybe she can barter some evening or weekend babysitting with the dentist…

This year our AP needed a filling too. Dentist didn’t do for free this time (once is probably all I’m going to get), but I helped pay for 50% of her costs.

PP is very right about the cost of the flight home being just as expensive as the procedure…

FormerSAaupair June 5, 2015 at 6:41 am

Yes, there might be…

First, I am sorry that this situation is happening and that agencies leave au pair’s health and host families gambling with luck when it comes to health coverage.

Since your au pair came into the country legally she may be able to get some help.
This may not be what most people would suggest, but totally legit.

Make a short statement of how much your au pair makes weekly to proof her income; ask her to gather her documents, ( passport, driver’s license & social security) and take her to the nearest Community Health Center that makes MassHealth applications. Since she is here legally and according to government guidelines her income is too low, she may qualify for temporary masshealth coverage. That should cover her emergency dental work and she should get and masshealth# immediatelty as the application is done.
After that, i would try calling Merrimack Valley oral surgeons for an opinion on her surgery and see if they would do it.

I hope this helps and best of luck!

Taking a Computer Lunch June 5, 2015 at 7:31 am

Because your AP is European, she could actually go home and apply for a second visa. I had a European AP who successfully did this (she wanted to extend but on the condition that she be permitted to go home for Christmas). She was able to obtain a new visa in 6 days.

Of course now is the wrong time of year to look for bargain flights to Europe, but in the old days I was able to fly standby on coach flights to Europe for next to nothing (I had to be willing to hang out in the airport not knowing if I were going to be able to fly or not). Do these type of flights still exist? Of course it would require both the AP and the HF to be flexible about the departure date and time.

However, at the end of the day, if having the medical care done here is the best solution, then negotiate with dentists. A wisdom tooth doesn’t have to be extracted by the best dentist (but really, if the bone is infected, then having the procedure done in a hospital will permit her to have access to better medical care if something goes wrong or she really needs IV antibiotics). In my experience, everything can be negotiated. Most hospitals have programs to help patients who have no — or inadequate — health insurance to pay for procedures – but you have to ask. (I paid for grad school by working as an out-patient registrar in an university hospital – and I told uninsured patients about the program up front but most of my colleagues did not.)

Finally, if she must have the procedure done in the U.S., then do the human thing and help her navigate the care. Medical care is the one thing my DH and I will assist with – it’s just that hard. She may need to borrow money from you, but hopefully her family will come through and help pay for the care.

OpinionatedHM June 5, 2015 at 8:20 am

Great ideas here. And like TACL the first thing I thought was lemons into lemonade – she can apply for another Visa while home and this have much more freedom to travel during her extension period.

I’d also add:
If you haven’t already, get your LCC in the loop ASAP if you haven’t already. Let her know what’s going on. Gauge whether she can help you and your AP navigate this situation. And get her started looking into in country APs just in case the worst happens and your AP doesnt return to finish out her extension period.

How does your AP feel about the situation? This type of surgery might involve anesthesia (it did when I had my wisdom teeth removed) and the recovery isn’t quick. Would she rather be home with the support of her family for this? Are you and your family in the position to give her support during the process if she has it done here? What if there are complications?

Having married someone from another country, I have had more experiences like this than I wish to with my in-laws. In defense of US abysmal Dental coverages, in my experience, we have much better preventative maintenance. I advise all my APs to have a thorough dental exam before they come here because dental care is so expensive.

CAtoTXMom June 5, 2015 at 8:31 am

We also had a Au pair who needed significant dental work only 4 months in on her assignment with us. We went to a few different dentists for quotes and decreased the price. We then worked out a payment plan for her so she could work off the cost over three months ($50-100 out of each paycheck). The au pair insurance she had reimbursed $500. There is also Care Credit available for those who don’t want to work out a payment plan themselves.

Patricia Eagan June 5, 2015 at 8:55 am

I would recommend going to lowincomedental.org and searching on Boston. You’ll find that there are a number of dental clinics where at a minimum your au pair could get a second opinion and hopefully a prescription. I see that Codman Square Health is one of the spots listed, I know the previous Director and can say that they provide excellent service.

Also, ask your LCC, there may be a host parent who is a dentist in your cluster (or a nearby cluster) who would consider doing the procedure at a lower cost. Our previous au pair had an orthopedic problem when she was here. She was helped out by a host mom/neighbor who is an ortho surgeon – a little different because her au pair health insurance was pretty good but her first in home!! evaluation was at no cost. And, our friend’s au pair had a broken bone that required surgery that was not fully covered by her au pair insurance, the ortho surgeon that the ER sent her to was a host dad and he kept the costs very low.

PC@GoAuPair June 5, 2015 at 11:07 am

From an agency perspective, I agree with TACL. Because the Au Pair is from Europe, she likely would be able to travel back home, get the dental work done and apply for a new visa. If she was from a country where there is a higher possibility of a visa denial, I wouldn’t advise it, but being from Europe she is likely okay to do that.
I do believe the most Au Pair agencies provide basic health insurance but not dental. I know that we advise all our Au Pairs, before coming to the US, to have their check-ups and see the dentist. I don’t think that most Au Pairs really understand how complicated insurance can be here in the US and how expensive dental work can be when you aren’t covered.
If she has to have the work done here, I would recommend contacting your agency and speaking with an insurance specialist. They may be able to recommend some other low cost solutions or recommend other dentists to talk to.

Texas5TimeHostMom June 5, 2015 at 11:10 am

We’ve had this issue twice! It is so hard to deal with! Our third au pair should have had her wisdom teeth out at home. She ended up having one pulled here, after two round of antibiotics didn’t clear up the infection. It was expensive, around $1000. Then, we were travelling with her at the time…another major infection on another wisdom tooth…we were in Costa Rica, and luckily found a dentist who did the procedure for $80. Yes, $80! I’m now strongly recommending all my new au pairs do preventative care at home before they leave, and I really encourage them to floss their teeth (I’m pretty sure many don’t). I’ve also found coupons for new patient xrays and cleanings and au pairs have used them to get their teeth cleaned while here, which does seem to help.

WestMom June 5, 2015 at 12:19 pm

Our first AP with the root canal didn’t know what floss was until I gave her a box.

SKNY June 5, 2015 at 12:25 pm

This hits home as my au pair (who just arrived) started complaining of tooth ache 2 days ago. We don’t really need care for the summer and are considering sending her home on vacation for a couple of weeks to get this taken care of. (although that would mean waiting another 3 full weeks for treatment).

TexasHM June 5, 2015 at 1:07 pm

Our current AP’s arrival was actually delayed by something very similar to this. She had a wisdom (not erupted) become infected/grow a cyst and started having sensitivity after she matched with us but before her plane ticket for orientation was bought. We pushed out her arrival date and she had multiple surgeries (and a post surgical infection that had to be drained and treated) and spent several days in the hospital. They removed that wisdom tooth and she lost her back molar on that side due to the cyst/infection getting to the bone and eating it away. They did also go ahead and remove the rest of her wisdom teeth but let’s be clear, this took WEEKS and was not a simple scheduled wisdom tooth removal so the fact that her situation sounds eerily similar is giving me pause.

How flexible is your situation? What does the AP want to do? Our AP was very glad she was in her home country to recover at home with her parents and her doctors. She said she couldn’t imagine having done it here. Can you go 2-3 weeks without care? I mean she’s an adult and it’s her choice and then you have to decide if you can live with whatever she decides, keeping in mind worst case is this becomes complex and she has multiple surgeries and ends up owing thousands and you are out childcare for several weeks at the same time.

My gut says send her home to have it done. If they can knock it out for free and get it done quickly and visa renewed then I think you would all be better off unless you have the flexibility to go without her at 100% for weeks and she has the $ and desire to try and tackle this here.

Mimi June 5, 2015 at 1:40 pm

Yikes! The price quoted has to be wrong, unless the teeth are horizontally impacted and deep in the bone. My niece recently had all four out (in your relative geo area) and it cost nowhere near what you were quoted (it was under $1000 total). My sister did some legwork and found it costs betwen $150-$500 per tooth, depending on the degree of impaction and level of eruption. She had no infection (yes, your AP should have gotten antibiotics imediately) and needed to have two teeth bisected in order to get them out.

Boston Healthnet is a network of local free or low cost dental and medical clinics in Middlesex and Suffolk Counties. I’m not sure if she would qualify through their programs, but definitely get a second opinion and don’t wait because a jaw bone infection can be serious business.

Amelie June 5, 2015 at 3:43 pm

Sorry, I’m a former au pair and really don’t have anything to say regarding your situation…

However, I can say that this is something that I don’t remember agencies talking to the au pairs about, but it’s highly important to go to a dentist for a check up before going to the US, and have all the necessary procedures done.

As host families, maybe you could talk to your future au pairs before they travel, most have no idea of how costly going to to the dentist in the US can be!

I’m from Brazil and dentist here are much cheaper than in the US, and they are very good. I had all my wisdom teeth removed a few years before becoming an au pair, by my orthodontist’s request, because they woud affect all my other teeth when they started to come in. Best decision ever!

Anonymous in CA June 6, 2015 at 2:56 pm

Such a good idea; i’m glad you mentioned this – it is not intuitive. I will add this to the little list of advice for new AP prior to arriving (dental exam, regular check up, along with all the other stuff).

CoffeeCapitolHM June 5, 2015 at 6:57 pm

We recently had a similar problem. We got a call when our arriving AP was in training school that she was complaining of a toothache. When she got here we had her see a dentist immediately! They gave her antibiotics for the infection, which helped her pain significantly. However, they were quoting $4000 to remove all 4 because all 4 wisdom teeth were horizontal and impacting. They said likely all would have to come out. We could do 1 for $1500, but likely she would need at least one more out soon. Through talking with some FB group, she was able to find that we have a charity here for low income that does dental work – Seattle Union Gospel Mission. We had to prove her income with a letter from the agency, but they were able to do the surgery for $10! For one, of course. Check with local charities, I had no idea this was an option. It took about a month to get the appointment and paperwork, but because the antibiotics cleared the infection she was no longer having pain. She should definitely get antibiotics right away if its infected – tooth infections are very dangerous to the heart. Look it up – its very real and very scary what can happen from an untreated infection in the mouth.

Angie Host Mom June 6, 2015 at 1:22 pm

Emergency tooth extractions are covered by our au pair’s travel insurance.. We know from experience!

Also I’ve signed my new AP up for a Dental HMO through blue shield for $19/month that provides significantly discounted services and free cleanings. Very limited dentist choice, but we found one that is ok.

Boston Area Host Mom June 7, 2015 at 2:50 pm

Thank you all for your great suggestions! I went to the dental school where my au pair was seen and got her records and x-rays to help both of us better understand the situation. The situation is not as dire as we though, it turns out that she has 2 partially impacted wisdom teeth (the emergency insurance will only cover the removal of fully impacted wisdom teeth). The wisdom teeth are vertical, not horizontal as was the case with Coffee Capital HM’s au pair. There was no infection in her gums, the tissue was just inflamed due to being difficult to clean.

I spoke to a friend who is a dental hygienist and she said that is totally normal with wisdom teeth and that the saline rinses should clear it up. I offered to pay the full amount to have the problematic wisdom tooth extracted and I also made her an appointment next week with my periodontist to get a second opinion. While I was doing all of this my au pair spoke with her mother who spoke to their family dentist who said to take the two wisdom teeth out. (This is the same dentist who 11 months earlier said that her wisdom teeth were fine and did not need to be removed).

Bottom line is that my au pair, with the help of her mother, decided to go back home to have her 2 wisdom teeth removed rather than take me up on my offer to pay for the removal of the problematic tooth. I thought that by doing this she could finish out her time commitment with us and then go back to the EU in January to take care of the remaining 3 wisdom teeth. My gut tells me that there is more to this story, and that her leaving is more about being homesick, and missing her boyfriend who is on the west coast. This au pair has only been with us for 1 month and the au pair before her was with us for 3 months (it was a bad match).

It has been difficult on all of us and now here we go again, heading into summer searching for a new au pair. I think that summer is the most stressful time for a working mom, and this is exactly the type of situation I was hoping to avoid. I am so frustrated and stressed out.

Boston Area Host Mom

Boston Area Host Mom June 7, 2015 at 9:30 pm

I forgot to add that my au pair will not get a new visa to return to the US because she said that once she goes back to her home country it would be too difficult to leave again.

MDHostMOM June 9, 2015 at 3:02 pm

I agree with everyone’s concern. I do want to note however that please consider carefully whether your family can afford to cover the cost before you ask a dentist you know (particularly a HF who is a dentist) to spend their time assisting your AP. My husband, who is a dentist, was asked to help three APs in just a few months. Their HFs are well off and can well afford to spend $1000 for dental work. He has to pay staff, etc. He does a fair amount of other pro bono work for individuals who are much worse off than an AP for a well off family.

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